Robert Graham Center Forum

Panelists Discuss Telehealth Potential for Primary Care

Telehealth has the potential to increase access and reduce costs, but physicians are still looking for the best ways to use the technology to improve patient care.

Family physician Wally Adamson, M.D., discusses the potential telehealth holds for delivering a better patient experience during a forum hosted by the Robert Graham Center for Policy Studies in Family Medicine and Primary Care.

Panelists discussed promising uses of telehealth in areas such as mental health and group visits during a primary care forum(www.graham-center.org) on Capitol Hill that the Robert Graham Center for Policy Studies in Family Medicine and Primary Care hosted on Nov. 9.

Telehealth in the form of video consults is well-suited to value-based payment models, panelists said, because the technology is structured for patient interaction, CPT codes are available and the amount of physician time can be recorded easily. However, network connectivity among primary care physicians, hospitals and subspecialists has not caught up with the ambitions of telehealth users.

"Telehealth is easy for patients, but it's hard for doctors and health plans," said Wally Adamson, M.D., a family physician who is staff vice president of LiveHealth Online, a telehealth service. "There are a lot of local initiatives, but it hasn't been translated onto a broader scale."

Adamson said telehealth both expands access and offers a lower-cost alternative to patients with high deductibles. Some stakeholders initially were concerned that such increased access might manifest as a spike in virtual visits on weekends, but Adamson said most patients access telehealth during normal business hours, and he noted that the technology is especially helpful with chronic care management.

"There's no reason health care can't deliver a customer experience like Nordstrom's," he said. "Moving from episodic care to chronic care is where the power of telehealth is."

Adamson pointed out that telehealth also could help some physicians stay in practice longer, giving the example of a physician with multiple sclerosis who cannot visit patients in person but could still offer remote consults.

Mental health care is another area where wider adoption of telehealth could be beneficial, and the Parkview Research Center in Fort Wayne, Ind., has received a grant to study the delivery of mental health services through telehealth. Indiana has one the nation's highest rates of teen suicide, and Tammy Toscos, M.S., Ph.D., a research scientist at Parkview, said teenagers face limited access to health care services, as well as social stigma for seeking out mental health care.

A program funded through the grant allows students to use their phones to interact with mental health professionals without revealing their identity.

"We need it for mental health," patient rights advocate Regina Holliday said of this usage of telehealth. "I love all the gadgets, but this could completely change the life of a young person. That's what's important."

Holliday noted that telehealth is particularly beneficial in rural areas, where patients either do not have access to behavioral health or cannot access it without their neighbors knowing.

Family physician Michael Rodriguez, M.D., said a telehealth platform he built years ago did not find much success among physicians or even among patients who were initially enthusiastic about it. But he believes that telehealth has more potential now because people have grown more comfortable using this type of technology, including for handling complex subjects.

"Now there aren't many people who go a week without participating in a teleconference," Rodriguez said.

He envisions telehealth expanding to group visits, but said the technology must first advance because most existing platforms only enable three people to participate at once.

To achieve the full potential of telehealth, however, payers must change the restrictive policies that discourage its use. For example, Medicare Advantage pays for telehealth only in rural or underserved areas and defines it strictly as two-way video technology.